Dr. Farid Mostamand.
I entered the exam room and saw one of my patients that I have not seen for over a year.
She was standing on the corner of the room holding a cane and leaning on another woman.
Before even I ask what happened she started crying. I asked her if I can help her to sit on the exam table.
She said. “sitting makes my pain worse.”
I said “Kathy, let me help you to lie down on the exam table. I put a pillow under your knees and that takes the pressure off your back. She introduced me to her daughter, Alice.
Alice and I helped her get on the exam table. I sat next to her after her daughter gave her a tissue to wipe out her tears, I said.
“I am sorry to see you in such a painful condition. Tell me what happened.”
She said. “Two days ago, I went to the airport to fly to San Francisco to see my son.
Alice took me to the airport. I went to the back of the car to pick up my briefcase when I experienced horrifying lower back pain. I could not straighten up my body, it locked, and I leaned against the car until Alice helped me to sit in the car.
The doctor at the emergency room examined me gave an injection and prescribed me some pain medication with advice to see my private doctor for further evaluation and treatment”
Kathy injured her lower back in an accident at work four years ago. Her employer sent her to my clinic for evaluation and treatment.
In 1995, I founded Crescent Health Center, A multi-specialty Clinic. My staff consisted of Orthopedic Surgeons, Neurosurgeons, Pain Management doctors, Chiropractors, internists, and acupuncturists. There was a total of five clinics in Southern California.
I reviewed Kathy’s chart. She had a 5mm disc bulge on her lower back based On an MRI report that I ordered 4 years ago. An EMG, nerve test, also revealed neuropathy on her right leg. I treated her for four weeks and she recovered from her injury and two months later she went back to her work.
During the past four years, I saw her once or twice a year for some minor flareups which did not last more than a week.
This time after two weeks of treatment she had only mild improvement. She was in a lot of pain each time she came to my office. After two weeks, I reviewed her chart with Dr. Philip Hay, an orthopedic Surgeon working in my office. Dr. Hay agreed with me that she should continue treatment for two more weeks if she did not improve, then he will see her for a second opinion.
The patients continued her treatment with me and took the pain medication that the ER doctor prescribed to her.
During the next two weeks, I saw her two times per week and during one of her visits, I found out that two months ago her husband left her and sent her the divorce paperwork in the mail.
I could see the anger and pain in her face when she talked about how her husband left her without any warning. She thought that she had a good life and it would never happen to her.
Learning about this part of the patient’s story, I knew this time her pain and the cause of her pain is different, and I have a difficult case on my hand. Based on my experience, the majority of the patient with stress and depression have an awfully slow recovery.
Dr. Philip Hay saw the patient and told me that we should order another MRI as her first MRI was 4 years ago, it might be a new injury or worse the pain might be secondary from other parts of the body.
I ordered an MRI test with an EMG. The test results were the same as it was 4 years ago with no new injury or exacerbation of the previous injury.
At this time Dr. Hay and I agreed to send her to Our Neurosurgeon in the office for a back surgery consultation.
Back surgery fails more than 70% of the time. In 40% of the time, the patient’s lower back pain gets worse after the back surgery. I have treated many patients with failed back surgery syndrome. So, my opinion not to send my patients too often for surgical consultation was justified. But in the 90s open back surgery was replaced by minimally invasive back surgery performed by a neurosurgeon.
I scheduled a surgical consultation in my office with Dr. Dennise Gross, The neurosurgeon was working in my clinic. Dr. Gross recommended to her a minimally invasive back surgery that she can go home the same day or after an overnight stay in the hospital. Kathy refused the surgery. By this time, she was consuming a copious Narcotic pain medication. She saw Dr. Hay once a month to just fill her pain medication.
One day Dr. Hay told me that Kathy is addicted to pain medication and her last lab test showed some damage to her kidney. I stopped her pain medication to prevent further damage to her kidney.
Kathy saw me two more times and stopped coming for her treatment.
After this incident, I had a meeting with the doctors in the clinic and insisted that they should cut off the patient from narcotic pain medication as soon as they can. I have seen enough patients addicted to prescribed pain medication.
Three months later, I saw Kathy again. She told me that she is seeing another orthopedic surgeon and get her pain medication from him. I asked the nurse to send her daughter to the exam room.
I sat on a chair in front of and said.
Kathy, you have been my patient for a long time, and I care about your health and recovery. There is not much I can do for you. If your back pain continues for more than a year, I am afraid it becomes chronic and hard to manage and treat. I do not believe your disc bulge is the cause of your pain this time. You had this for many years. I treated you for a few of those flares up that lasted less than two weeks. You recovered fast each time.
This time, it is different. Lifting the briefcase was a trigger to your back pain, not the cause of your pain. The stress of divorce is the cause of the pain. Until you do not deal with the emotion of divorce stress your back pain will not go away. I have seen much stress-related lower back pain. If we can not take care of stress, the lower back pain may never go away. It doesn’t matter how many specialists you see.
Dr. Hay was right to stop your pain medication. Based on your lab test, if you do not stop these prescribed pain medication, soon you will have kidney failure. There is over 5 million kidney failure each year in the United States that require dialysis. Many of them are a result of addiction to prescribed pain medication.
I am not saying your lower back pain is in your head. All I am saying that the stress, negative thoughts, and worries are the cause of your pain, not the disc bulge in your low back.
Please get help, go to a drug addiction center, and get help before, it is too late. Tears were rolling over Kathy’s face. She wiped her tears and said. “Dr. Mostamand. You are right. Whatever you said make sense. But I can no longer live with pain. I thought about killing myself by overdosing on pain medication.
I do not see any point in living. I do not have anything to look forward to. I loved my husband and I still do, and I thought it will never happen to me. I know what you are saying, but I am lost, and life has no meaning for me anymore.”
I said. “Life has no meaning for me. This is your diagnosis for your lower back pain. Your back condition did not change, your thought, emotion, and your outlook to life have changed. So, stopped going from doctor to doctor for pain medication. I assure you it is not the right treatment for your lower back pain.
It is time to stop coming to see me or any other doctors, we can no longer help you if you could not help yourself with the right mental attitude and outlook on life.
My professional advice to you is to see a psychologist and work to improve the way you think and handle negative thoughts and emotions. Do yoga and meditation, start walking. Find a new group of friends, go to nature. start a hobby. She left that day without committing to follow my advice.
I was worry about Kathy. One day I told my secretary to call her to see how she was doing. The phone number was disconnected, and I did not see Kathy for over two years.
One day my secretary said. “Kathy called today and wanted to make an appointment with you. I told her that he does not have an opening for two weeks. He sees patients only three days a week. She said she wait and does not want to see another doctor in the office.”
Two weeks later, the nurse handed me a file and told me that the patient is in room number 5. I looked at the chart and saw Kathy’s name. I do not think many doctors say, I am so excited to see this patient today. But I was genuinely excited to see Kathy today
I looked at her new history form and did not find any obvious changes, but when I looked at her pain chart, she checked the box with mild or no pain. I grabbed her file from my desk and walked fast toward the room number 5.
I knocked and enter the room and saw a youthful, h skinny, happy, and full of life woman in front of me. Holding a little boy, about a year old. She passed the boy to Alice and asked me if she can hug me.
I said. “I am dying to hear your story. I could have not recognized you if I saw you on the street”
“How much time you have?”
“As much time as you need to tell me your story.”
She said. “After, I left your office. I went to my doctor and got another prescription for my pain medication. I continued the same routine for the next three months. Got my pail, lie down on the floor in the front of the TV, and ate as much junk as I could. I gained over 50 lbs. s that exacerbated my pain more. My daughter was pregnant, and she moved with me to help me physically and financially. We share the rent and other expenses that helped both of us. I could not live alone by myself anymore. I could not stand to cook or walk to the bathroom. I was dependent on My daughter.
She gave me an ultimatum if I do not go to Rehab for my drug addiction, she will place me in a nursing home. After a few days, the fear of nursing home became real. But still did not give me that motivation to stop taking pain medication.
In the last months of her pregnancy, she could not help me anymore. She hired a caregiver to come once a week to shower me and cook food to last for a week. I received a disability check, but it was not enough to pay for a caregiver. My daughter was not making enough money that can support me much longer. “
The nurse knocked on the door and said. “Dr. Mostamand, your next patient is waiting for a long time.”
I told her. “give me a few more minutes, I will be out.”
I said to Kathy. “I want to listen to your story, please continue.”
She continued. “Nothing changed until my grandson, Zack was born. Seeing him for the first time changed everything for me. All the conversation I had with you on my last visit refreshed in my memory and had a different meaning to me. I never had that feeling. Your voice echoed in my mind, you need to change your outlook on life. Two weeks later I entered rehab. I started with yoga and meditation, started writing, and wanted to get well enough to take care of Zack so my daughter can go back to work.
This gave me a new purpose and outlook on life. A week after rehabilitation, for the first time, I was able to sleep for five hours without pain. I was semi-unconscious for most of the day as I was taking too much pain medication.
When zack was Zack three months old, my pain improved significantly, and my daughter was able to go back to work. I found a new meaning for life, that meaning gave me a purpose and a new life. You are so right. The cause of my lower back pain was not having a meaningful life and let the worry and fear run my life. I will never go back to my old life.”
I saw Kathy periodically for the next few years. She had some mild exacerbation responded with treatment. She changed her view of life and as a result, she changed her life. She remarried and works part-time while Zack is in preschool. Zack was the only doctor that could help her.
What hurts you, blesses you. Darkness is your candle. These pains you feel are messengers. Listen to them. Rumi